Public Health: Disease, Epidemic & Pandemic Threat (merged thread) [Archive]

selil

07-21-2008, 04:11 PM

In evidence to a House of Lords committee, ministers said that early warning systems for spotting emerging diseases were "poorly co-ordinated" and lacked "vision" and "clarity". They said that more needed to be done to improve detection and surveillance for potential pandemics and called for urgent improvement in rapid-response strategies.

I keep saying it, people in the health care industry say, but nobody listens. Universal healthcare is a national security issue not a liberal welfare issue. The early warning system in the United States is the healthcare system through the health departments in the thousands of jurisdictions. If people can not afford health care they stay away until it is to late and the infection/spread rates are totally out of control. This is true for bio threat/terrorism, natural occurring threats, and emerging threats. But, it isn't sexy, it is tainted by politics, and it doesn't involve guns so nobody wants to take it on. The very mobile poor/poverty population engaged in service industry with rapid/expansive/integrated contact with large segments of the population are exactly who should be covered and exactly who are not covered.

Oh well.

Watcher In The Middle

07-27-2008, 05:27 AM

you use the term "Universal healthcare", you are screwed. That's the standard code phrase (political speak) for 100% government controlled and provided healthcare, and battle's over at that point - you lose.

Is what we have now really that good - well, not really (and that's being polite). Could we have designed such a disorganized out-of-control rolling cluster of a health care delivery system if we had tried to? - probably not - to get this screwed up, we had to let this whole mess improve with age.

But, doesn't matter - "Universal healthcare" is DOA because of everything it brings to the table.

On the associated topic,
The early warning system in the United States is the healthcare system through the health departments in the thousands of jurisdictions. If people can not afford health care they stay away until it is too late and the infection/spread rates are totally out of control.

That's only partially true, and there's much, much more to it. And "Universal Healthcare" will in no way make it better - probably little, if any effect at all. Here's why (as an example I'm personally aware of).

Most local Health Departments part in the health "food chain" can be broadly summarized as follows (bottom to top):

1. Local Entities/providers:
1.a Local health care providers (individuals/practices)
1.b Hospitals, clinics
2. Local Health Departments:
2.a Environmental Health (Food Safety; Well & Septic, Solid Waste, Radon, etc., etc., etc.)
2.b Clinical Health (provide services to individuals; WIC, etc.)
3. State Public Health
4) Federal Public Health:
3.a CDC
3.b NIH
3.c DHS (don't even get me started on them; with their "grants" to local health departments of such useful items as HAZMAT suits that nobody ever used, radiation detectors, 'lightweight' GPS units which were the weight and size of Chicago street paving bricks, etc.)
3.d Others

Ok, let's start here: Most of the work gets done by the locals. Any hospital doing even a halfway decent job (which honestly, most of them do a decent job at this part) already have in place a rapid response environment (usually digital) for tracking "unusual events" such as infections, unusual situations, etc. The problem in most cases isn't the locals at all.

The problem (at least here in IL) is with our wonderous, quite inept state government. Right around 2001/2002, I believe, the feds set aside $$$$ for each state to create real time digital reporting, run by each state public health agency to quickly identify and report such outbreaks and incidents to the state public health agencies, and consequently to the feds - bypassing the local health departments, because they had been "ineffective" up to this point.

So, our state took the money and ran with it - giving big bucks to a politically well connected firm to create from scratch a new, miracle, magical digital system which would allow the state folks to track everything in every which way known to mankind. And what they did was to spend all the big money (and it was supposedly ended up being in excess of $10 mil, but who really knows) to create a digital version of the paper process that already was in place.

Now, there were at least 2 private companies that already had digital systems that existed, were battle tested by the hospitals which were using them, but no, we got to create our own from scratch. Which we did, right here in IL. And guess what, the local Health Departments are charged with training and getting all the local health providers to use this monstrosity of a system - and guess what, it blows chunks. I mean, it is really terrible to use, nobody who is on the front lines wants to use it, you can easily kill 15+ minutes just putting a single record into this thing, it's a complete and total waste.

And then just to top things off, and let's make things just a little bit worse, then you have to throw in HIPA (Health Insurance Privacy Act) requirements right on top of this thing, so let's just make things a little more complex and even more difficult.

So, here's the hard reality. It's 9:30 AM, and I've got a patient with symptoms that probably should be reported, but we're on the treadmill of seeing patients, and I don't have 5 minutes, much less 15 minutes. It's going to wait, and hopefully staff can get some free time to deal with the reporting system. Course, I'll have to get the 185 page manual out with the step-by-step instructions, and the 3 level logins and passwords required to get in, oh, and btw, what's our state assigned 30 character identifier for our medical practice?

Oh, and btw, the feds are supposedly as happy as clams about IL and their new infectious disease reporting system, even though most everybody who really has to use it thinks it's a mostly worthless piece of crap.

Btw, if you really want to see the true back story, get a copy of the paper reporting forms used before this new system was put in place, and then get a copy of the full user manual for the new system. After you look at the two separate items, it's pretty apparent that the overriding design process was: "Do it the same way it's always been done, only do it a little better".

/End of rant

Uboat509

07-27-2008, 07:12 AM

Universal healthcare is a national security issue not a liberal welfare issue

Socialized medicine isn't going to fix this, or any other problems. Watcher covered the issues as they pertain to this particular problem but that is just scratching the surface of the problems with socialized medicine.

SFC W

selil

07-27-2008, 02:18 PM

Norfolk

07-27-2008, 02:44 PM

Watcher I agree pretty much with the issues you laid out, but the problem still remains that the indigent plague carrier is not going to seek any kind of medical attention unless it is to late. Unfortunately you are correct that the political baggage is tiresome, but as thought leaders we have to go beyond and at least give correct recommendations. The number and type of cases (advanced symptomatic) seen in emergency rooms proves that people without insurance don't even enter the medical monitoring system. Ever. We have to get beyond "socialized" as bugaboo words and simplistic axioms of rejection. We also have to get beyond a standard of "perfect" in talking about implementing these types of systems. The problem is complex and I can not claim to have all of the answers but I can see that the current system is badly broken. The political punditry surrounding healthcare is fallow ground for ideas and concepts. Department of defense has a mission to look beyond the borders at threats external. Law enforcement has a mission to look at threats of criminal nature. The pandemic threat is an internal threat with a substantive history at least as rich with examples as war. Yet even though the death toll in previous pandemics equalled major wars it is given little to no equivalent concern. The reasons are legion. Mostly the political footballs of failed medical policy, big pharma, the AMA, and various political profit seeking constituencies.

Certainly WIM is correct that such a system ("Universal Healthcare") would almost certainly be politically DOA before a pandemic; in the wake of a pandemic, of course, there would be much gnashing of teeth and bitter reproach for not anticipating the threat and establishing a system to deal with it. I wonder what the political watchword for that might be.

But...just to throw a monkey in that wrench, when the SARS scare was on, the public health care system in Toronto was almost overwhelmed by just a few hundred cases, and most of the deaths occurred amongst medical staff. That however, has been attributed largely to inadequate senior leadership at various political levels and within some hospital administrations.

Uboat509

07-27-2008, 04:07 PM

selil

07-27-2008, 05:45 PM

As far as I can see, there are now two issues being discussed here. One is "Universal Health Care" which is both a political and practical non-starter and the other is the creation of some sort of early warning system. As has been noted, that early warning system is already in place though it needs work. It worked fairly well during the Anthrax incident a few years ago. CDC does a decent job, not perfect, but good enough. I would be very wary of creating more government beauracracy to try to make it better (or anything else for that matter).

SFC W

Actually you are slicing health care and early warning prematurely early. Also, the targeted population during the anthrax event (not threat as people actually got sick) was not the general population. A pandemic is the "population" as with SARS or Bird Flu. Further the CDC has expressed they do not have nor can they respond to a general outbreak. They are an identification and warning agency. More akin to military intelligence operations than operational armor battalions. The wariness you express is the result of the political process. The military has universal healthcare (if you can call tri-care healthcare). The problem is that priorities are askew in considering the specific issues.

Don't get me wrong or attribute political ideology that would be incorrect or misplaced. I can see an issue, identify the problems, recognize the severity of the threat along with the likeliness of an actual event. Without devolving into political speak. I am not an expert at pandemic, but I have read many journal articles, been to many conferences, and listened to people who are experts. This is an issue that simply isn't discussed because of the political baggage of the Clinton presidency.

Yet it is incredibly important.

If I told you that I have a stealth weapon that could wipe out a third of the military without attribution or warning and there is no offensive analog how much would you spend on detection measures? Oh, and it will wipe out a third of the contractor staff, the political representation, and likely families supporting the military? I know fear mongering but some of the conferences talk about increasing threat vectors the longer it doesn't happen with increasing virulence and mortality due to the population interactions.

Watcher In The Middle

07-27-2008, 06:42 PM

Originally posted by Selil:

Watcher I agree pretty much with the issues you laid out, but the problem still remains that the indigent plague carrier is not going to seek any kind of medical attention unless it is to late. Unfortunately you are correct that the political baggage is tiresome, but as thought leaders we have to go beyond and at least give correct recommendations. The number and type of cases (advanced symptomatic) seen in emergency rooms proves that people without insurance don't even enter the medical monitoring system. Ever. We have to get beyond "socialized" as bugaboo words and simplistic axioms of rejection. We also have to get beyond a standard of "perfect" in talking about implementing these types of systems. The problem is complex and I can not claim to have all of the answers but I can see that the current system is badly broken. The political punditry surrounding healthcare is fallow ground for ideas and concepts. Department of defense has a mission to look beyond the borders at threats external. Law enforcement has a mission to look at threats of criminal nature. The pandemic threat is an internal threat with a substantive history at least as rich with examples as war. Yet even though the death toll in previous pandemics equalled major wars it is given little to no equivalent concern. The reasons are legion. Mostly the political footballs of failed medical policy, big pharma, the AMA, and various political profit seeking constituencies.

Ok, so let's get started & do some serious "thought processing" here:

Initial Analysis: First off, the above post by Selil should be the starting point. But the following rules need to be attached to it:

01 The entire concept of "Universal Healthcare" does not apply to this process in any way, shape, or form. NONE. This step is a basic requirement, for political purposes. If we don't do this, and stick to it, the entire process is DOA.
02 The information release compliance areas of HIPA (the rules are arcane, and the penalties, even for accidental disclosure are draconian) are currently also applied to public health agencies. These HIPA requirements need to be eliminated for (a) public health reporting purposes, and (b) for private entities making such reports solely to local public health agencies. We need accurate, detailed information fast, and guess what, HIPA requirements as applied out in the real world makes almost all of that process impractical.

So once 01 & 02 are done, now we can get serious about building a Pandemic EW (early warning) system. If you want to do it right the first time, and get it done quickly, here's how.

03 Forget the typical software design, where you get tons of committees together & re-build the "Camel". Takes way too long, and probably everybody here can imagine the results.
04 Solution: Take $500 mil, call up Larry Page and Sergey Brin (Founders of a little bitty corporation known as "Google"), tell them there is a project for the development and implementation of a Pandemic EW System (PEWS???) that is essential to the National Security of the United States of America, and it's Google's responsibility to make it happen. They have 3 years to get it done, and $500 mil. Federal anti-trust regs do not apply to this project.

Give them a copy of this thread, with all the posts, and then get the hell out of their way. Let them have at it.

Ok, so there's my "solution" for building a useful, workable, highly functional Pandemic EW System - ID the best and the brightest, tell 'em what the problem is and set the stage for them to handle it, turn them loose, and get the hell out of the way.

Then there's the entire healthcare issue. Oh yeah, that's a jewel. Next post...

Uboat509

07-27-2008, 06:53 PM

Actually you are slicing health care and early warning prematurely early. Also, the targeted population during the anthrax event (not threat as people actually got sick) was not the general population. A pandemic is the "population" as with SARS or Bird Flu. Further the CDC has expressed they do not have nor can they respond to a general outbreak. They are an identification and warning agency. More akin to military intelligence operations than operational armor battalions.

That is by design. CDC was always intended to be a coordinating agency as well as performing some research functions. A true epidemic is going to be beyond the capabilities of any one government agency anyway. CDC will coordinate the response of the elements already on the ground to respond to the threat as well as providing information and (I believe) advisers to the local responding elements. CDC does that pretty well as far as I know. The real inherent weakness in the system is just like in MI, the sensors. For the system to work, the sensor (doctor, nurse, health care professional etc.) has to a) recognize that there is something that needs to be reported and b) actually report it. Easier said than done. The only way to get around that would be to place someone in each hospital, clinic etc. to report to the CDC. That's not an especially practical solution. Again, more government bureaucracy is not the answer.

The wariness you express is the result of the political process. The military has universal healthcare (if you can call tri-care healthcare). The problem is that priorities are askew in considering the specific issues.

Nah, TRI-CARE isn't really any better or worse than an average HMO and in fact Tri-West is a subsidiary of Blue Cross/Blue Shield (a fact they don't seem to advertise :)).

Don't get me wrong or attribute political ideology that would be incorrect or misplaced. I can see an issue, identify the problems, recognize the severity of the threat along with the likeliness of an actual event. Without devolving into political speak. I am not an expert at pandemic, but I have read many journal articles, been to many conferences, and listened to people who are experts. This is an issue that simply isn't discussed because of the political baggage of the Clinton presidency.

Yet it is incredibly important.

It is also an issue of all the times that wolf has been cried over the years. In the eighties, AIDs was going to kill us all, then it was Ebola, then Mad Cow disease, then SARs and most recently (my personal favorite) H5N1 bird flu. All of these were going to kill us all and none really lived up to the hype. I am a medic. I know that there is some nasty stuff out there waiting for the chance to give us a nasty death (other than tofu, I mean, which is a work of pure culinary Evil) but the hysteria around the "epidemics" that I mentioned mixed with all the other stuff than is going to kill us (plastics, cholesterol, well bad cholesterol or not enough good cholesterol or too many triglycerides, or eggs, no wait a minutes eggs are good for you, no wait they're bad again, no they're good, no bad and so on) have led to a significant amount of apathy on the part of John Q. Public and if John doesn't really care about it then the politicians aren't going to pretend to care either.

SFC W

AdamG

07-31-2014, 05:29 PM

London (AFP) - Fears that the west African Ebola outbreak could spread to other continents grew with European and Asian countries on alert and a leading medical charity warning the epidemic was out of control.

Doctors Without Borders (MSF) said the crisis gripping Guinea, Liberia and Sierra Leone would only get worse and warned there was no overarching strategy to handle the world's worst outbreak of the disease.

US Christian charity Samaritan's Purse was temporarily withdrawing its non-essential staff from Liberia, it said, citing regional "instability and ongoing security issues".

Hong Kong announced quarantine measures for suspected cases, although one woman arriving from Africa with possible symptoms tested negative, while the EU said it was ready to deal with the threat.

The International Civil Aviation Organization (ICAO) has held talks with global health officials on potential measures to halt the spread of the disease.

http://news.yahoo.com/uk-holds-emergency-talks-growing-ebola-threat-084704564.html

SWJ Blog

09-25-2014, 04:05 PM

Beating Ebola From The Sea (http://smallwarsjournal.com/blog/beating-ebola-from-the-sea)

Entry Excerpt:

--------
Read the full post (http://smallwarsjournal.com/blog/beating-ebola-from-the-sea) and make any comments at the SWJ Blog (http://smallwarsjournal.com/blog).
This forum is a feed only and is closed to user comments.

SWJ Blog

11-06-2014, 04:26 AM

Ebola and the African Responsibility (http://smallwarsjournal.com/jrnl/art/ebola-and-the-african-responsibility)

Entry Excerpt:

--------
Read the full post (http://smallwarsjournal.com/jrnl/art/ebola-and-the-african-responsibility) and make any comments at the SWJ Blog (http://smallwarsjournal.com/blog).
This forum is a feed only and is closed to user comments.

AdamG

09-30-2016, 02:56 PM

Spinoff of the now-locked 2008 thread (http://council.smallwarsjournal.com/showthread.php?t=5784&highlight=disease), with a new plot twist for planning ops.

Epidemic transmission of Zika virus (ZIKV) has rapidly occurred in the Americas, with most cases limited to mild or asymptomatic disease.1,2 To date, nine deaths from ZIKV infection that were unrelated to the Guillain–Barré syndrome have been confirmed in adults.1 Here, we report a rapidly progressive, fatal ZIKV infection acquired outside the United States and secondary local transmission in the absence of known risk factors for ZIKV infection.
http://www.nejm.org/doi/full/10.1056/NEJMc1610613?query=featured_home&

AdamG

10-31-2016, 07:39 AM

Although the Ebola and Zika outbreaks in the United States never reached the catastrophic heights projected by some public health experts, these crises demonstrated that the United States is not immune to potentially devastating pandemic events threatening the health and security of the nation.
#
However, major gaps in the pandemic preparedness efforts of the Department of Homeland Security (DHS), one of the primary agencies leading the nation’s public health preparedness efforts, leave the United States unprepared for a pandemic event, according to a recent audit by the DHS Office of the#Inspector General (OIG).
#
Specifically, DHS OIG said the Department does not always provide clear guidance or sufficient oversight of component’s pandemic plans, implementation of pandemic readiness training, completion of reporting requirements and identification of the personal protective equipment and supplies needed for a pandemic response.

http://www.hstoday.us/industry-news/general/single-article/dhs-pandemic-preparedness-needs-improvement/f24c332bc5dcb924a181e76445f9841a.html

AdamG

10-31-2016, 07:41 AM

It’s estimated around 700,000 people die each year because of drug-resistant infections.
The UN Secretary General calls it a “fundamental threat” to global health and security. And a special meeting of the UN General Assembly was recently held to address the issue.
On current trends, the death-toll is expected to rise to around 10 million per year by 2050 unless more is done.#
So how prepared are we for future pandemics? And what measures are being undertaken to ensure we win what Mark Balskovich from the Centre for Superbug Solutions calls an “arms race” with bacteria?
http://www.abc.net.au/radionational/programs/futuretense/drug-resistance-and-coming-pandemic/7959344

What should companies do to protect its workers and the surrounding community from a pandemic? NIOSH's Lisa Delaney spoke to 2016 National Safety Congress attendees about emergency preparedness.
http://ehstoday.com/health/nsc-2016-when-pandemic-strikes-will-you-be-prepared

AdamG

01-13-2017, 08:57 PM

Separate thread for max visibility, then Dave can reposition as appropriate.

Anyone with half-a-functioning imagination can see where this problem could be exploited by the Bad People for asymmetrical purposes.

yesterday afternoon, the CDC also released a report about a Nevada woman who died after an infection resistant to 26 antibiotics, which is to say all available antibiotics in the U.S. The woman, who was in her 70s, had been previously hospitalized in India after fracturing her leg, which led to an infection of the bone. There was nothing to treat her infection—not colistin, not other last-line antibiotics. Scientists later tested the bacteria that killed her, and found it was somewhat susceptible to fosfomycin, but that antibiotic is not approved in the U.S. to treat her type of infection

https://www.theatlantic.com/health/archive/2017/01/a-superbug-resistant-to-26-antibiotics-killed-a-woman-itll-happen-again/513050/#pt0-840044

http://i.imgur.com/a8OlulE.jpg

davidbfpo

01-17-2017, 11:11 PM

From an unheard of website via Twitter, a report that opens with:
Despite recent headlines declaring the success (https://www.statnews.com/2016/12/22/ebola-vaccine-results/) of an experimental Ebola vaccine, the world is not fully prepared for future epidemics — and not in position to use vaccines to prevent another deadly outbreak, a report (http://www.cidrap.umn.edu/completing-development-ebola-vaccines) published Tuesday warned.

Link:https://www.statnews.com/2017/01/17/ebola-vaccine-warning/

AdamG

02-14-2017, 01:14 AM

They are called superspreaders, the minority of people who are responsible for infecting many others during epidemics of infectious diseases. Perhaps the most famous superspreader was Typhoid Mary, presumed to have infected 51 people, three of whom died, between 1900 and 1907.
https://www.washingtonpost.com/news/to-your-health/wp/2017/02/13/disease-superspreaders-accounted-for-nearly-two-thirds-of-ebola-cases-study-finds/?utm_term=.27e12c5295da

Applicable advice -> https://youtu.be/vtSmfws0_To

AdamG

02-21-2017, 01:20 PM

Tourists with more discretionary income and hubris than brains. Yay.

"Visiting beautiful places like this inspires people to protect tropical ecosystems and the species that live here," Olival says. "At the same time, we need to recognize that there may be potential health risks when people and wildlife come together, and that's why we're working to understand and limit those risks."

"We found 48 new viruses in the surrounding forest," Olival says, "including a virus related to SARS in bats that roost in the cave."

http://www.npr.org/sections/goatsandsoda/2017/02/21/508060742/the-next-pandemic-could-be-dripping-on-your-head

AdamG

04-20-2017, 07:20 AM

(CNN)Experts say we are "due" for one. When it happens, they tell us,#it will probably have a greater impact on humanity than anything else currently happening in the world.

And yet, like with most people, it is probably something you haven't spent much time thinking about. After all, it is human nature to avoid being consumed by hypotheticals until they are staring us squarely in the face.
Such is the case with a highly lethal flu pandemic. And when it comes, it will affect every human alive today.

Pandemic flu is apolitical and does not discriminate between rich and poor. Geographical boundaries are meaningless, and it can circle the globe within hours. In terms of potential impact on mankind, the only thing that comes close is climate change. And, like climate change, pandemic flu is so vast, it can be challenging to wrap your head around it.

- Dr Sanjay Gupta
http://www.cnn.com/2017/04/07/health/flu-pandemic-sanjay-gupta/

davidbfpo

07-14-2017, 08:07 AM

Five threads have been merged today, following a review before posting the next article. The thread title has been amended to add Epidemic.

davidbfpo

07-14-2017, 08:13 AM

Via The Conversation, an academic site, I found this article; which starts with:
During the fallout from the 2014 Ebola outbreak in West Africa, which killed more than 11,000 people (http://www.who.int/mediacentre/factsheets/fs103/en/), one of the questions asked of the World Health Organisation (WHO) was why it hadn’t reacted more quickly. The four-month delay in pinning down the cause of the disease that erupted in Guinea’s remote Guéckédou province in December 2013 allowed what might have been a localised event in a single village to turn into the biggest infectious disease crisis of recent times....Ebola was not a West African disease. So why would anybody suspect it had broken out there?
Link:https://theconversation.com/africas-missing-ebola-outbreaks-80301?

AdamG

09-03-2017, 01:49 AM

In the past few years, there have been so many "superbugs" appearing in hospitals around the world that we here at Goats and Soda haven't had the time or resources to report on all of them.
But a new type of pneumonia emerging in China seems so important that we dropped what we were doing to write about it.
Doctors in Hangzhou in southeastern China have detected a a type of pneumonia that is both highly drug-resistant and very deadly. It also spreads easily.
The bacterium — a type of Klebsiella pneumoniae — killed five people in an intensive care unit in Hangzhou in 2016, researchers reported Tuesday in the journal Lancet Infectious Diseases.

http://www.npr.org/sections/goatsandsoda/2017/09/02/547892623/triple-threat-new-pneumonia-is-drug-resistant-deadly-and-contagious

Thinking music https://www.youtube.com/watch?v=GPnc_RKjd-U

AdamG

10-17-2017, 12:54 PM

While Canadian health officials have extensive plans to ensure people survive a future influenza pandemic, they’ve also made macabre recommendations for the nation’s funeral homes for those who don’t.

“In a pandemic, each individual funeral home could expect to handle about six months work within a six- to eight-week period,” the Public Health Agency of Canada warns on a web page about the management of mass fatalities during a pandemic flu.

https://globalnews.ca/news/3652652/canada-pandemic-public-health-agency-canada-funeral-home/

AdamG

11-28-2017, 06:29 PM

(CNN)The age-old killer scarlet fever is on the rise in England and East Asia, according to research published Monday in The Lancet Infectious Diseases journal, and investigators don't know why.
"Whilst current rates (in England) are nowhere near those seen in the early 1900s, the magnitude of the recent upsurge is greater than any documented in the last century," said study author Theresa Lamagni of Public Health England, the agency that funded the analysis. "Whilst notifications so far for 2017 suggest a slight decrease in numbers, we continue to monitor the situation carefully ... and research continues to further investigate the rise."

http://www.cnn.com/2017/11/27/health/scarlet-fever-mystery-study/index.html

AdamG

03-11-2018, 07:43 AM

Might as well just call it 'Captain Tripps'.

Two mainstream media takes -

Unknown 'Disease X' flagged by World Health Organization, could cause 'serious international epidemic'

Scientists warn that an unknown "Disease X" poses a major health risk and could cause a "serious international epidemic" in the future.
Disease X was listed by the World Health Organization as one of eight priority diseases. Others on the list include Ebola, Zika and Lassa fever.

http://www.nydailynews.com/news/world/unknown-disease-x-serious-international-epidemic-article-1.3866762

What is Disease X?
Disease X is not a newly identified pathogen but what military planners call a “known unknown”. It’s a disease sparked by a biological mutation, or perhaps an accident or terror attack, that catches the world by surprise and spreads fast.
By including it on the list, the WHO is acknowledging that infectious diseases and the epidemics they spawn are inherently unpredictable. Like the Spanish flu which killed 50m to 100m people between 1918 and 1920, Disease X is the catastrophe nobody saw coming until it was too late.

Where might it come from?
One source of Disease X could be the deliberate utilisation of infectious disease as a weapon.
While bio-weapons have been used since the middle ages (the Tartars catapulted the cadavers of plague victims into the besieged seaport of Caffa in 1346, for example), new scientific developments including gene editing and an exponential increase in computing power make it easier than ever to develop lethal biological agents.
The US and USSR explored bio-weapon development during the Cold War and both continue to hold live cultures of deadly pathogens, including the smallpox virus, in secretive and (hopefully) secure labs. More recently, the Iraqi military toyed with botulinum toxins under Saddam Hussein, Al Qaeda operatives experimented with anthrax and, in 2014, a laptop captured from Islamic State (IS) was found to contain instructions on how to weaponise the plague virus.

https://www.telegraph.co.uk/news/0/beware-disease-x-mystery-killer-keeping-scientists-awake-night/

From WHO -

World Health Organization 2018 annual review of the Blueprint list of priority diseases
http://www.who.int/blueprint/priority-diseases/en/

AdamG

06-30-2018, 05:26 PM

Virologists will attempt to identify every virus in the world that has the potential to jump from animals to humans, in the hope that collecting such information with give health workers a head start in dealing with a future outbreak.

Scientists believe the ambitious 'virus hunter' project will not only find and - hopefully neutralise - 'disease X' before it strikes but also unearth viruses 'Y' and 'Z' . Others, however, remain unconvinced the approach is a good use of funds.

Most of the big disease outbreaks of the last 100 years have originated in animals – from Ebola which came from bats to HIV that came from chimps to the 1918 Spanish Flu which jumped from birds to humans.

Now scientists have set up the Global Virome Project, with backing from USAID, which has the ambitious target of identifying all the viruses in the world that could one day jump from animals to humans.

https://www.telegraph.co.uk/news/2018/06/29/scientists-hunt-diseases-x-y-z/

AdamG

07-18-2018, 07:57 PM

A PATHOGEN THAT resists almost all of the drugs developed to treat or kill it is moving rapidly across the world, and public health experts are stymied how to stop it.

By now, that’s a familiar scenario, the central narrative in the emergence of antibiotic-resistant bacteria. But this particular pathogen isn’t a bacterium. It’s a yeast, a new variety of an organism so common that it’s used as one of the basic tools of lab science, transformed into an infection so disturbing that one lead researcher called it “more infectious than Ebola” at an international conference last week.

The name of the yeast is Candida auris. It’s been on the radar of epidemiologists only since 2009, but it’s grown into a potent microbial threat, found in 27 countries thus far. Science can’t yet say where it came from or how to control its spread, and hospitals are being forced back into old hygiene practices—putting patients into isolation, swabbing rooms with bleach—to try to control it.

https://www.wired.com/story/the-strange-and-curious-case-of-the-deadly-superbug-yeast/

AdamG

07-23-2018, 02:38 PM

CDC Main Page for Candida auris
https://www.cdc.gov/fungal/candida-auris/index.html

AdamG

08-28-2018, 02:01 AM

For over a year, the Chinese government has withheld lab samples of a rapidly evolving influenza virus from the United States — specimens needed to develop vaccines and treatments, according to federal health officials. Despite persistent requests from government officials and research institutions, China has not provided samples of the dangerous virus, a type of bird flu called H7N9. In the past, such exchanges have been mostly routine under rules established by the World Health Organization. Now, as the United States and China spar over trade, some scientists worry that the vital exchange of medical supplies and information could slow, hampering preparedness for the next biological threat.

https://www.msn.com/en-nz/news/world/china-has-withheld-samples-of-a-dangerous-flu-virus/ar-BBMwyrr

AdamG

08-28-2018, 12:32 PM

Food for thought, Ebola wise.
http://raconteurreport.blogspot.com/2018/08/and-hits-just-keep-on-coming.html

AdamG

09-06-2018, 12:30 PM

This year marks the 100th anniversary of the 1918 influenza (flu) pandemic that swept the globe in what is still one of the deadliest disease outbreaks in recorded history.

In September 1918, the second wave of pandemic flu emerged at Camp Devens, a U.S. Army training camp just outside of Boston, and at a naval facility in Boston. This wave was brutal and peaked in the U.S. from September through November. More than 100,000 Americans died during October alone. The third and final wave began in early 1919 and ran through spring, causing yet more illness and death. While serious, this wave was not as lethal as the second wave. The flu pandemic in the U.S. finally subsided in the summer of 1919, leaving decimated families and communities to pick up the pieces. Scientists now know this pandemic was caused by an H1N1 virus, which continued to circulate as a seasonal virus worldwide for the next 38 years.

https://www.cdc.gov/features/1918-flu-pandemic/index.html

AdamG

09-23-2018, 12:07 PM

In the summer of 1918, as the Great War raged and American doughboys fell on Europe’s killing fields, the City of Brotherly Love organized a grand spectacle. To bolster morale and support the war effort, a procession for the ages brought together marching bands, Boy Scouts, women’s auxiliaries, and uniformed troops to promote Liberty Loans –government bonds issued to pay for the war. The day would be capped off with a concert led by the “March King” himself –John Philip Sousa.

Within 72 hours of the parade, every bed in Philadelphia’s 31 hospitals was filled. In the week ending October 5, some 2,600 people in Philadelphia had died from the flu or its complications. A week later, that number rose to more than 4,500. With many of the city’s health professionals pressed into military service, Philadelphia was unprepared for this deluge of death.

https://www.smithsonianmag.com/history/philadelphia-threw-wwi-parade-gave-thousands-onlookers-flu-180970372/

AdamG

10-06-2018, 06:49 AM

LOS ANGELES — Health officials on Friday reported a typhus outbreak in Los Angeles County and say it has reached "epidemic levels" in the city of Pasadena. Twenty cases have been reported in Pasadena, most in the last two months, health officials told NBC News, noting that a normal year there would typically only see five infections. The city of Long Beach, Calif., has 12 cases so far in 2018 — double the normal annual number, said Emily Holman, the city's infectious disease response coordinator.

https://www.nbcnews.com/news/us-news/typhus-reaches-epidemic-levels-parts-los-angeles-area-n917271

AdamG

10-17-2018, 02:56 PM

More possible cases of a rare, polio-like virus have been reported, health officials say. The Centers for Disease Control and Prevention has been investigating more than 360 possible cases of acute flaccid myelitis dating back to 2014. The disorder, which mainly affects children, can paralyze a child's arms and legs. The average age of AFM patients is 4 years old, Nancy Messonnier, director of the CDC's National Center for Immunization and Respiratory Diseases, said Tuesday.

Brittany Fowler of the Maryland Department of Health told USA TODAY that there have been five possible cases of AFM in the state, all in children under 18. The Minnesota Department of Health announced six cases were reported in children under 10. The CDC has confirmed 62 cases in 22 states. The CDC said the cause of most AFM cases is unknown, but a few cases have been linked to other viruses. Symptoms are similar to poliovirus, West Nile virus and adenoviruses, which makes it difficult for doctors to diagnose.

https://www.usatoday.com/story/news/nation-now/2018/10/16/polio-like-afm-affecting-more-kids-maryland-health-department/1656548002/

AdamG

10-23-2018, 07:16 PM

The picture we have of the 1918 flu pandemic is vastly more detailed today than it was 20 years ago, let alone 50 or 100 years ago. But it’s nowhere near complete. Pathologist Jeffery Taubenberger of the US National Institute of Allergy and Infectious Diseases – the man who in 2005, with his colleague Ann Reid, published the genetic sequence of the virus responsible for the pandemic – said at a recent conference there were still many unanswered outstanding questions.

Researchers all over the world are working hard to answer them. But what they have already uncovered might surprise you.
http://www.bbc.com/future/story/20181016-the-flu-that-transformed-the-20th-century

AdamG

10-27-2018, 05:27 PM

Cases of measles in Europe have hit a record high, according to the World Health Organization (WHO). More than 41,000 people have been infected in the first six months of 2018, leading to 37 deaths. Last year there were 23,927 cases and the year before 5,273. Experts blame this surge in infections on a drop in the number of people being vaccinated.

https://www.bbc.com/news/health-45246049

AdamG

10-31-2018, 12:55 AM

Health officials reported 17 new cases and 10 deaths in the ongoing Ebola outbreak in the Democratic Republic of Congo, making this the nation's third largest outbreak of the virus, according to an update from University of Minnesota's Center for Infectious Disease and Research and Policy in Minneapolis.

Eleven of the new Ebola cases occurred in the city of Beni. The remaining six occurred in the nearby city of Butembo. As of Oct. 28, the World Health Organization confirmed 274 total Ebola cases and 174 deaths linked to the outbreak.

The Congo has experienced ten Ebola outbreaks, including the current one. This outbreak has now surpassed the 2007 Ebola outbreak in the Congo's Luebo region, which caused265 cases and 187 deaths.

On Oct. 28, health workers conducted Ebola response training with 8,000 young people in Butembo and Benito "increase the awareness actions for young people who are often at the root of resistance because of a lack of knowledge of the disease and its danger," Congo officials said, according to CIDRAP.

As of Oct. 29, 24,142 Congolese people have received an Ebola vaccine, including 12,464 people in Beni and 1,295 people in Butembo.

https://www.beckershospitalreview.com/quality/ebola-outbreak-now-congo-s-3rd-largest-with-270-cases.html

davidbfpo

10-31-2018, 08:46 AM

This stand alone thread started in 2008 and has today 64,182 views. The theme of public health and the threat from disease, epidemics and more also features in another thread - so I have merged them.

Adam G is the main contributor to both threads.

AdamG

11-19-2018, 12:55 PM

National Public Radio (US thing) is galvanizing a citizen militia to track this season's flu.

https://www.sciencefriday.com/segments/tracking-the-flu-in-sickness-and-in-health/

AdamG

11-22-2018, 02:01 PM

“Influenza pandemics are like earthquakes, hurricanes and tsunamis: they occur, and some are much worse than others,” says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “The idea that we would not have another 1918-like event is foolish.”

But when that will happen, he continues, is impossible to predict: “For all we know, it could be starting as we speak.” It’s also impossible to predict exactly how things will play out when a Spanish flu-like strain does reemerge – but we can make some educated guesses.

http://www.bbc.com/future/story/20181120-what-if-a-deadly-influenza-pandemic-broke-out-today

AdamG

11-22-2018, 02:04 PM

Adam G is the main contributor to both threads.

Obscure joke is obscure. https://i.kym-cdn.com/entries/icons/facebook/000/009/113/tumblr_lslzl7YUPS1qfm4opo1_500.jpg

Meanwhile, back at the topic...
Human infection with avian influenza A(H7N9) virus – China / Disease outbreak news 5 September 2017

On 4 August 2017, the National Health and Family Planning Commission of China (NHFPC) notified WHO of one additional laboratory-confirmed case of human infection with avian influenza A(H7N9) virus in China.
http://www.who.int/csr/don/5-september-2017-ah7n9-china/en/

AdamG

12-08-2018, 08:48 AM

Attacks by armed groups happen on a daily basis across Congo's North Kivu province, where the Ebola virus has been spreading since August, infecting almost 500 people and killing more than 270. It is now the second-biggest outbreak ever, after the vast epidemic that swept through Guinea, Sierra Leone and Liberia between 2014 and 2016.

The constant insecurity in North Kivu has proved an enormous obstacle, thwarting attempts to the contain the virus. By WHO's estimate, the outbreak will go on for at least another six months.

This is the first Ebola outbreak during which health workers have had to regularly don bulletproof helmets and vests. To reach at least 20 percent of Ebola-affected areas, health workers need armed police or U.N. escorts, said Michel Yao, WHO's response coordinator in Beni.

The U.S. government withdrew its only personnel in the region in late August and has no plans to redeploy them. The WHO has 300 specialists from around the world in North Kivu. Those on the ground describe a chaotic effort to either negotiate with or simply avoid the region's various militias.

"It turns into a cat-and-mouse game - we are the mouse trying to evade the armed groups," said Anoko, who is from Cameroon. But Anoko, whose job entails conducting extensive interviews with locals, cautioned against the assumption that health workers are being targeted for their work. "There's been decades of war, it cannot be so simply understood," she said.

https://www.lmtonline.com/news/article/Like-a-horror-film-The-efforts-to-contain-13449195.php

AdamG

12-13-2018, 04:52 PM

Interesting collection of observations

1. http://raconteurreport.blogspot.com/2018/12/ebola-2018-update-lying-with-statistics.html?m=1

2. http://raconteurreport.blogspot.com/2018/12/questions-i-get-questions.html?m=1

3. http://raconteurreport.blogspot.com/2018/12/why-ebola-sucks-and-why-its-going-to.html?m=1

4. http://raconteurreport.blogspot.com/2018/12/last-thoughts-for-now-nightmare.html?m=1

AdamG

01-01-2019, 06:21 PM

LAST SPRING, AS it does every year, the World Health Organization released a list of infectious diseases that its experts think are especially high-risk—ones that could blow up into epidemics and for which there are no treatments or vaccines.

The list has been created every year since 2014, when the Ebola epidemic in West Africa took the world by surprise. This year’s specimen included the pathogens that public health people consider the usual deadly suspects: Ebola and other hemorrhagic fevers, MERS and SARS, and mosquito-borne Zika and Rift Valley Fever. But there was also a novel entry: Disease X.

“Disease X” doesn’t actually exist. The WHO wasn’t warning against a specific pathogen; it was reminding public health and medicine how important it is to be ready for any new illness—especially since existing tests and might not be precise enough to detect a new disease that has epidemic potential, and treatments may not be potent enough to stop it.

In the four years that the list has been published, no emerging infection has been serious enough to rise to the level of Disease X: a pathogen that could sweep the world before science catches up. But a new syndrome, acute flaccid myelitis, or AFM, is providing the first proof of the need for that warning. As perplexing to diagnose as it is to treat, AFM is demonstrating how difficult it can be to understand and predict any new disease. And the challenge of tracking an uncommon illness is giving us a glimpse of how our surveillance systems will struggle to counter the world-spanning epidemic that Disease X may turn out to be.
https://www.wired.com/story/new-disease-next-global-epidemic/

AdamG

01-08-2019, 09:30 PM

Century After the 1918 Flu Pandemic: Why Are We Still Concerned Today?
Source: National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division (HMD)
Date Published: 11/26/2018
Format: Video or Multimedia
Annotation: A century after the 1918 flu pandemic wiped out more than 50 million people worldwide, this event from the National Academy of Medicine and the Forum on Microbial Threats discusses how to prepare for the next flu pandemic and prevent a global catastrophe. Speakers highlight progress in science, public health, global governance, and cross-sectoral alliances for pandemic flu preparedness. [less]
URL: https://nam.edu/event/a-century-after-the-1918-flu-pandemic-why-are-we-still-concerned-today/
Authors: Dzau, Victor; Fukada, Keiji; Garrett, Laurie; Fauci, Anthony S.; Fidler, David P.; et al.
Type: Conference/Meeting Material
Access Notes: Link to nine videos from the event: https://www.youtube.com/watch?v=JeF-Yj85liA&list=PLqRL5HO_hA8efr54FcwEh60bnBF2d8-lq&index=1

AdamG

02-24-2019, 10:39 PM

Presented as an illustration.

February 21st -

The measles outbreak in Madagascar has grown to a total of 68,912 cases since October, including 926 deaths, the World Health Organization in Madagascar reports (computer translated).
http://outbreaknewstoday.com/measles-vaccination-campaign-madagascar-cases-climb-69000/

February 22nd -

In a follow-up on the measles epidemic in the Philippines, health officials are now reporting 11,459 measles cases, including 189 fatalities since the beginning of the year though Feb. 20 , an increase of 3,000 cases and 50 deaths in four days.
http://outbreaknewstoday.com/philippines-measles-outbreak-tops-11000-cavite-declares-state-calamity-95635/

February 23rd -

The measles outbreak in the Pacific Northwest now has 70 confirmed cases, The Oregonian reported Saturday, with 65 of those cases coming from Clark County, Oregon, where the outbreak began on Jan. 1. Four more instances of the disease, which had been all-but eradicated in the U.S., have been reported in nearby Multnomah County, and one has been reported in Seattle, Washington.
https://www.thedailybeast.com/pacific-northwest-measles-outbreak-grows-to-70-confirmed-cases

AdamG

03-08-2019, 04:10 PM

Just as we can find applicable insights from combantants' historical accounts, so too can we find from outbreak survivors.

Laura Spinney, author of Pale Rider, wrote: “When asked what was the biggest disaster of the twentieth century, almost nobody answers the Spanish flu…The Spanish flu is remembered personally, not collectively. Not as a historical disaster, but as millions of discrete, private tragedies.”
https://1918flustories.com/?fbclid=IwAR2fux2Xbn_jKjwGzfY9zNHuNUCB9AWcvrelptsS 74Efzu31gjFlXzknqAI

AdamG

03-11-2019, 02:13 AM

Let's consider the unintended consequences.

(CNN)Militants attacked an Ebola treatment center in the Democratic Republic of Congo, killing a police officer as the nation battles a growing epidemic that has killed hundreds. The World Health Organization said a staff member was injured in the Saturday attack by armed groups that targeted the center again last week. WHO Director-General Tedros Adhanom Ghebreyesus was in the nation on a three-day visit and spoke to officials and staff at the center after the attack.
*
Two attacks on Ebola treatment centers in North Kivu last month forced Doctors Without Borders (also known as Medecins Sans Frontieres or MSF) to put some humanitarian efforts on hold.
Doctors Without Borders was targeted in an attack in Katwa on February 24 and another one three days later in Butembo, the medical aid organization reported last month.
MSF suspended its activities in Butembo and Katwa but said it would continue Ebola-related activities in other towns in North Kivu and neighboring Ituri province.
The two provinces are among the most populous in the nation and border Uganda, Rwanda and South Sudan.
https://www.cnn.com/2019/03/10/health/ebola-drc-congo-who-death/index.html

AdamG

03-11-2019, 02:17 AM

Last year, with the centennial of the 1918 flu looming, I started looking into whether America is prepared for the next pandemic. I fully expected that the answer would be no. What I found, after talking with dozens of experts, was more complicated—reassuring in some ways, but even more worrying than I’d imagined in others. Certainly, medicine has advanced considerably during the past century. The United States has nationwide vaccination programs, advanced hospitals, the latest diagnostic tests. In the National Institutes of Health, it has the world’s largest biomedical research establishment, and in the CDC, arguably the world’s strongest public-health agency. America is as ready to face down new diseases as any country in the world.

Yet even the U.S. is disturbingly vulnerable—and in some respects is becoming quickly more so. It depends on a just-in-time medical economy, in which stockpiles are limited and even key items are made to order. Most of the intravenous bags used in the country are manufactured in Puerto Rico, so when Hurricane Maria devastated the island last September, the bags fell in short supply. Some hospitals were forced to inject saline with syringes—and so syringe supplies started running low too. The most common lifesaving drugs all depend on long supply chains that include India and China—chains that would likely break in a severe pandemic. “Each year, the system gets leaner and leaner,” says Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “It doesn’t take much of a hiccup anymore to challenge it.”

Perhaps most important, the U.S. is prone to the same forgetfulness and shortsightedness that befall all nations, rich and poor—and the myopia has worsened considerably in recent years. Public-health programs are low on money; hospitals are stretched perilously thin; crucial funding is being slashed. And while we tend to think of science when we think of pandemic response, the worse the situation, the more the defense depends on political leadership.

When Ebola flared in 2014, the science-minded President Barack Obama calmly and quickly took the reins. The White House is now home to a president who is neither calm nor science-minded. We should not underestimate what that may mean if risk becomes reality.

https://www.theatlantic.com/magazine/archive/2018/07/when-the-next-plague-hits/561734/

AdamG

03-11-2019, 02:10 PM

Infectious diseases—some that ravaged populations in the Middle Ages—are resurging in California and around the country, and are hitting homeless populations especially hard.

Los Angeles recently experienced an outbreak of typhus—a disease spread by infected fleas on rats and other animals—in downtown streets. Officials briefly closed part of City Hall after reporting that rodents had invaded the building.

People in Washington State have been infected with the diarrheal disease shigella, spread through feces, as well as Bartonella quintana, or trench fever, which spreads through body lice.

Hepatitis A, also spread primarily through feces, infected more than 1,000 people in Southern California in the past two years. The disease also has erupted in New Mexico, Ohio, and Kentucky, primarily among people who are homeless or use drugs.

Public-health officials and politicians are using terms like disaster and public-health crisis to describe the outbreaks, and they are warning that these diseases can easily jump beyond the homeless population.

https://www.theatlantic.com/health/archive/2019/03/typhus-tuberculosis-medieval-diseases-spreading-homeless/584380/

AdamG

03-13-2019, 01:31 PM

A global flu pandemic is a realistic threat that the world must prepare for, the World Health Organization said March 11.

The organization revealed its global flu strategy for 2019-30, which focuses on addressing both seasonal flu outbreaks and global pandemics.

The WHO's flu strategy outlines two main initiatives:

Ensure every country has a strong flu surveillance and response program
Develop tools to better prevent, detect or treat the flu that are accessible to all countries
"The threat of pandemic influenza is ever-present," WHO Director-General Tedros Adhanom Ghebreyesus, PhD, said in a press release. "The question is not if we will have another pandemic, but when. We must be vigilant and prepared — the cost of a major influenza outbreak will far outweigh the price of prevention."
https://www.beckershospitalreview.com/quality/who-head-next-flu-pandemic-is-matter-of-when-not-if.html

8 Things to know about pandemic influenza
11 March 2019
The threat of pandemic influenza is ever-present. A pandemic can arise when a new influenza virus that hasn't affected humans before emerges, spreads and causes illness in humans.

Influenza viruses are unpredictable – we can never be certain of when or from where the next pandemic will arise. However, another influenza pandemic is inevitable. In this interconnected world, the question is not if we will have another pandemic, but when.

To protect people across the globe from this threat, the WHO has released a Global Influenza Strategy for 2019-2030. The new strategy is the most comprehensive and far reaching influenza strategy that WHO has developed. The strategy outlines a framework for WHO, countries and partners to work together to prepare for, prevent, and control the influenza.

https://www.who.int/news-room/feature-stories/detail/8-things-to-know-about-pandemic-influenza

AdamG

03-17-2019, 09:54 AM

Socialism at work.

Infectious Diseases Spike amid Venezuela’s Political Turmoil
Scientists say the rise in illnesses is due to a combination of government suppression of research, a lack of disease data and climate change

Venezuela was once a leader in vector-borne disease prevention and control. In 1961 the World Health Organization certified the South American nation as the first in the world to eliminate malaria from the majority of its territory; in fact the WHO used the malaria-eradication program Venezuela developed in the 1950s as a public health model. That and other efforts reduced the prevalence of many vector-borne diseases to manageable levels through the 1990s. But in recent years a confluence of events—some political and economic, others environmental—has reversed these gains.

Here's the take-away.

The review co-authors warn the crisis could spark an epidemic in neighboring countries, as Venezuelans are emigrating by the millions. The authors say Venezuelan migrants suffered 45 and 86 percent of malaria cases in the bordering northern Brazilian municipalities of Pacaraima and Boa Vista, respectively. But it is difficult to ascertain how many migrants may have brought disease with them, and how many were infected after they reached host countries. Co-author Martin Llewellyn, an epidemiologist at the University of Glasgow, acknowledges this uncertainty, and adds his team plans to conduct molecular epidemiology studies to determine the origins of infection.
https://www.scientificamerican.com/article/infectious-diseases-spike-amid-venezuelas-political-turmoil/